Impalpable breast cancer

Abstract

The burden of non-palpable breast cancers continues to rise with increasing implementation of screening programmes as mammography, extension of inclusion age in established programmes and increasing accessibility to advanced imaging modalities, such as MRI. The use of the WGL has persisted for half a century owing to the limitations of radiological technology relating to their dependency on radioisotopes, and to the lack of formal U/S training programmes available to surgeons that enable them to confidently perform intra-operative U/S. Technological advances, such as those using magnetic nanotechnology, which have allowed the principles of radio guided surgery to be applied without the need for radioisotopes, might provide a mainstream alternative to WGL, once their efficacy is supported by rigorous clinical trials. The use of therapeutic U/S devices, such as HIFU, provides an opportunity for non-invasive real-time surgical tumor visualization and therapy, enabling what was once hidden from the surgeon to be seen for the first time. The use of such technology will be driven by patients' demands for improved outcomes and by formal assessments of financial benefits to justify their purchase by health-care providers. Surgeons must keep up with this process, and lead future changes to reach the goal of complete recovery for every patient. Eventually we can conclude that none of the minimally invasive treatment approaches is used in current clinical practice for treatment of breast cancer and are used only for study settings. Surgery remains the standard local treatment of breast cancer, with radiation therapy if needed clinically. The value of these treatments compared with traditional open surgery needs to be confirmed by large prospective studies. In addition, cost-effectiveness and long-term effect on cosmetic outcomes still need to be investigated.